Bwick

Hi, I'm a CNS from the northern midwest region and looking to relocate in NC, SC, Georgia or possibly northern Fl states. I'm a CNS for critical care with lots of experience. Any folks live/work in these states have advice for me and some names of exceptional institutions? Thanks Sue:nurse:

We are looking at our orientation process. How long an orientation are you giving new grads in different areas of the hospital? Medical, surgical, peds, OB, ICU, orthopedics, etc. Is it all clinical or are classes included (what kind of classes) Thanks Sue

How long is your general nursing orientation and what kinds of things are included? We are looking at revamping ours and are curious about what other places are doing. Thanks Sue

Thanks for your input! Any and all is apreciated! Sue

We are starting to see more IO catheters with some of our trauma patients. I've been looking for some info and there isn't a ton out there - especially nursing info. If you use some of the newer devices, what kind of dressing do you use? Also, when removing - how long do you apply pressure? Thanks for your help Sue

Our hospital has a centralized non-nurse monitor tech that monitors patient throughout the hospital on tele (all areas except ED, ICU and OR). The nurses on the floors are not trained to read monitors and rely on the MT to tell them about the rhythm and base practice off that. Does anyone else have a problem with that? Also, how often do you mount strips for patients on tele.

When the literature came out that using saline down an artificial airway for suctioning was a bad practice, we stopped doing it. We have added using biopatch and chlorhexidine in central line management due to EBP. We keep the HOB elevated on vent patients due to EBP. Etc Sue

I have two questions. 1. How often are the stips mounted for telemetry patients? 2. Do you use non-nurse monitor techs and do they monitor units where the nurses are not trained on telemetry? We currently do and feel it may be a questionable practice to have a non-nurse tell an RN what's going on with thier patient and the nurse needs to act on that info. Thanks Sue

Thanks for your help. Would anyone be able to send me more specifics on what's required to differentiate the upper levels. I want to be sure that our program ends up being "reasonable" - don't want to overwhelm with requirements that would turn someone off. Thanks Sue

Does your facility have clinical ladders or any other clinical advancement program for bedside hospital nurses? Would you mind sharing with me about your program? We are in the process of re-vamping our clinical ladder program and I wanted to see what's out there that works well and is satisfying to staff. Thanks Sue ([email protected])

thanks for your responses. Our IV solutions are from Baxter and it says on the bag "for Rx only" on all bags, even the plain ones. Our pharmacy department is interpretting that to mean that we include them in the lock up. It's not just about the money. We had a JCAHO review last Sept and they were very picky about med storage. They made comments about even securing our crash carts or putting them in plain site because "someone" could role the cart down the hall and into the stairwell to raid it. They are taking medication security very seriously. I don't know about your facility but ours has a LOT of fixed payers, so it doesn't matter if you charge it to the patient - for the most part, you will not get it back.

With the medication safety mandates, how are you handling IV solutions? Do all of them need to be locked up? Do just those solutions with meds like potassium in them? How are you handling this mandate? Thanks Sue

When I was 15 I had surgery on my hand. I was scared and didn't have a clue. No one explained anything to me, no one comforted me, I felt totally alone. I figured it didn't have to be like that and maybe I could help. I keep that thought in the back of my mind whenever dealing with patients and families. Sue

We are looking at this at our facility. Am wondering how other facilities are dealing with the issue of getting help to the patient before they code. If you have a team - who makes up the team? How are they activated? Thanks sue

Our anesthesia department wants to have and IV via the hotline, an arterial line set up and the rapid infuser set up - meaning everything spiked and ready at all times. We are not that big of a hospital. There will be many times where this stuff is not used for days. What do you do in your facilities - how long do you leave these IV's set up? Thanks for your help Sue

Thanks for the response. Would you be willing to share a copy of your policy? Do you still check pH if feedings are going via tube? How often do you check for pH? Thanks Sue

Would appreciate it very much! :)

Begalli, would you be willing to share a copy of your order set? Thanks for all the great information! [email protected] Sue

Sorry, I got an extra letter in the email address [email protected]

We currently are doing continuous epidural infusions for OB, some vascular surgeries, some abdominal surgeries, some thoracic surgeries, etc. Anesthesia would now like to move on to patient controlled epidurals (like PCA but via epidural catheter). Anyone willing to share experiences and maybe their policy. Thanks much [email protected]

Thanks to all that responded to my question. I think we will be changing our policy. :)

There certainly are shifts that leave you feeling like you accomplished nothing but I think you will find that in many in-patient units in a hospital setting - ED included. Nurses are carrying heavier loads and often don't have the time we'd like to care for our patients. You are doing good. You are watching over your patients. You will encounter unhappy people in any work environment. Don't let them get you down. At the end of your shift, instead of focusing on what you didn't accomplish, focus on what you did do. I monitored the patient closely so they wouldn't get worse. I checked the blood sugar every hour and titrated the insulin to keep thier blood sugar under control. I comforted. I gave pain meds to those in pain. And on and on.

Help! I'm reviewing our enteral nutrition policy. I would like to see that we get a chest X-ray or KUB to verify placement in a patient with an NG tube. Basically if anything is going into the tube (meds and/or feeding) we should have more evidence of placement than listening for air. What does your hospital do? Thanks

We are considering having patients post cardiac interventional procedure with Reopro infusion to go to our step-down unit instead of ICU. They occasionally take interventional patients but have not taken them with Reopro. Staffing is 3:1 or 4:1 on this unit but they are very busy with many transfers in and out during the day. They also have all types of patients, not just cardiac. What does your facility do? What's the patient ratio? Thanks

We are considering transferring patients after interventional procedures with Reopro to the step down unit. They occasionally get post interventional procedures but not with Reopro. Most interventional patients go to the ICU (combined ICU). RN ratio is 3:1 or 4:1 on step-down. What are other hospitals doing? What is your ratio? Thanks